Will the holidays be healthy or hazardous for a heart failure patient?

I am beginning to feel a positive glow in anticipation of the approaching holiday season.  I look forward to the opportunity to rejoice with family, reflect on the meaning of Christmas and experience spiritual fulfillment.  But at the same time I also have a bit of apprehension.  The holiday season can get a little crazy and demanding with (1) pressure to fill your calendar with parties and traditional activities so that you won’t miss out (2) the pressure to find the right gifts for your loved ones, and (3) trying to avoid an adverse impact on one’s weight.  The last item is troublesome for heart failure patients because of the fluid and diet restrictions we must observe.

The holidays are times where we may temporarily overindulge because we feel we need to be “merry”, or at least what the retail industry would encourage us to believe is merry.  By the time the year ends, one begins to feel as old and out-of-shape as Father Time.  But despite the stress, the worst case scenario for most people is that they may have to diet to shed the holiday pounds they gained when they threw caution to the wind.  But for us who are impacted by significant diet errors, common sense told me that totally ignoring diet concerns could be risky.
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I suspected readers might think I was exaggerating.  So I looked for articles about how heart failure patients manage during the holiday season.  Consequently, this post will have a number of quotes about medical studies or from medical organizations and doctors.  This is because I want to impress upon readers, especially those who are heart failure patients or know a heart failure patient, that this is a subject that deserves attention and perhaps advanced planning.

I found an abstract on the National Institutes of Health website that said:  “Studies suggest increased cardiac morbidity and heart failure exacerbations during winter months with a peak around the holiday season. Okay – a slight digression here.  The term “heart failure exacerbations” seems absurd to me.  The Cambridge English dictionary says that to exacerbate is to make something that is already bad even worse.  If your heart has failed that seems beyond bad to me.  How much worse can it get short of death?
Really guys, can we just refer to this as something like exacerbation of the patient's heart pumping impairment?????

Regardless of how we refer to this phenomenon, the conclusion of the abstract is a wake-up call.  Why are heart failure patients more susceptible to increased cardiac impairment or even death during the holiday season?  Well, it seems that it all boils down to the fact that in many cases, the diet discipline that has become routine for the successful heart failure patient has slipped during the holiday. 

A December 2016 article on the US News and World Report website said that for patients with underlying heart disease – particularly congestive heart failure or CHF – the holidays can present a particular challenge. Overeating and the added salt in many holiday meals and goodies can put heart patients at risk for a CHF flare. Patients with CHF can experience shortness of breath and swelling called edema, and many wind up in the hospital. Many heart failure patients must maintain a fine balance in fluid intake during normal times, and the holidays can make this even more difficult.

According to an article on the Reuters website doctors reviewed data on 22,727 patients admitted to Einstein Medical Center in Philadelphia with heart failure between 2003 and 2013.  Most were African American and female, with other diseases in addition to heart failure, including hypertension, diabetes, high cholesterol and coronary heart disease. The average age was 68.  While I do not fit all the categories just listed, I believe in many respects I am comparable to the patients who were subjects of the study.

The study found that every year on Christmas Day, 3.6 patients were admitted, on average. In the four days after Christmas, that number rose to 6.5 per day. On other days in December, however, the average number of patients being admitted for heart failure was 5.5.  Similar patterns were seen for Thanksgiving, New Year’s Day and Super Bowl Sunday.

The article said that symptoms like weight gain and shortness of breath can worsen 24 to 48 hours after eating high salt foods, and urged people to be vigilant in how they manage their heart condition.  The article also presented an interesting yet scary fact:  “Eating a single hot dog could have up to 1,000 mg of sodium so eating in moderation is important.”  Wow – a single hot dog isn’t that big.  But it amounts to, depending on your doctor’s orders, anywhere from ½ to ¾ of a sodium allotment for the day! 

Is it any wonder that researchers found that Independence Day is one of the holidays when heart issues are more likely to flare up.  Perhaps the fireworks blind us to sodium counts, but many will consume hot dogs and other salt laden food with wild abandon.  If you have edema, this can be a risky proposition.
 
The website for the University of Southern California has an article from December 2011 regarding entitled “Heart Attacks, Other Emergencies Spike During Holidays.  According to this article:  “The holidays are a time when we really increase the amount of salt and fat we eat.  Most people don't notice the difference.  However, there are certain people -- for example, those with heart failure -- for whom the slight increase in salt intake could result in big problems,” said Ameya Kulkarni, MD, a cardiology fellow with the UCSF Division of Cardiology.  “And if your heart is already working hard to get oxygen because of narrowing of coronary arteries, then stress will tax your heart, and that demand for more oxygen could cause ischemia or even a heart attack.”
 
According to the Cleveland Clinic website, “Holiday heart syndrome is when overeating and overindulging in alcohol leads to an irregular heartbeat.  Holiday heart can happen if you don’t typically drink alcohol, but then have a few at a holiday party, or you binge-drink and then develop an irregular heartbeat called atrial fibrillation.  Atrial fibrillation increases your risk of stroke, heart attack and heart failure.
 
Let me reassure you that I am not trying to scare people to death.  I do not want to have heart failure patients live in the land of fear.  But we do need to live in the land of fact and fluid retention.  Heart failure patients know what it is like to feel like Lake Erie is residing either in their gut or in their ankles.  So just give some advance thought to your holiday diet choices!
 
Observing diet restrictions is so crucial during the holiday season that the American Association of Heart Failure Nurses provides a list of good holiday food choices on their website.  There are a number of suggested tips to how to enjoy a holiday meal but not blow the salt budget and end up in the emergency room.  You should take a look at this website.  Happily, turkey is on the list of suggested holiday delights along with many other tasty items.  I think heart failure patients will be able to find more than enough choices to feel like they are celebrating.
 
In addition to checking out the site yourself, you may want to share it with the friends or family members you will be celebrating with this holiday season.    You would be amazed at how many people do not understand the importance of cutting sodium.  We all have seen articles about studies that “prove” you don’t need to worry about salt.  But  your doctors know the tendency of sodium to cause water retention in heart failure patients, which will just make your life a lot more difficult.  So to well-meaning friends and family who tell you about the latest sodium study, just nod and say “uh–huh” and keep on following your doctor’s instructions.
 
Even if your friends and family do understand it, they may not realize how much sodium lurks in food that you wouldn’t think would be sodium laden.  (For example, someone recently reminded me, bread has much more sodium that one would imagine).  So perhaps the information on the AAHFA website will help your loved ones realize how critical a low sodium diet is for you, and how to achieve the goal of a low sodium Thanksgiving meal that will work for you.
 
But, because we are all human and want to have a little splurge, here is a technique that seems to have helped me stay within sodium restrictions and still enjoy some holiday treats.  Again, it’s a matter of balance.  Since my family has Thanksgiving dinner in the mid to late afternoon, I can eat fruit and things with next to no sodium during the rest of the day.  That way, if my sodium budget is a little high in the afternoon, my budget for the day will be where it should be as I was so good with my diet choices at other times during the day.
 
I hope I haven’t put a damper on the holiday season.  But I want heart failure patients to be aware of the risks of significant and extended deviations from restrictions regarding food, sodium, fluid and alcohol.  I want all of us heart failure patients to have a good time, but to also be around to celebrate many holidays to come.